CK19、Galectin-3、HBME-1、p27及CyclinD1在甲状腺乳头状癌中的表达及意义

背景与目的:甲状腺乳头状癌的诊断有时会很困难,而淋巴结转移是甲状腺乳头状癌局部复发的主要原因并影响预后.本研究探讨CK19、Galectin-3、HBME-1、p27及CyclinD1在甲状腺乳头状癌中的表达特点和诊断价值以及p27、CyclinD1与乳头状癌淋巴结转移间的关系.方法:收集2005年1月至2008年12月间在我院手术的50例甲状腺良性病变患者 (结节性甲状腺肿40例,甲状腺腺瘤10例)及50例甲状腺乳头状癌(经典型40例,滤泡型10例) 患者的手术标本,用免疫组化EnViSion法检测CK19、HBME-1、Galectin-3、p27及CyclinD1的表达.结果:细胞质或细胞膜均有CK19、Galectin-3和HBME-1三种标志物表达,但p27和CyclinD1则在细胞核表达.CK19、HBME-1、Galectin-3在甲状腺乳头状癌中的表达阳性率分别为100%、96%和100%,而在良性病变中则为10%、10%和6%,两者比较差异有显著性(P<0.01).p27在甲状腺乳头状癌的表达阳性率为14%,而在良性病变中则为84%,两者比较差异有显著性(P<0.01).CyclinD1在甲状腺良、恶性病变中的表达阳性率分别为68%和78%,两者间差异无显著性(P>0.05).在甲状腺乳头状癌患者中,CK19、Galectin-3和HBME-1共同表达者占98%(49/50),其中伴p27低表达者占90%(45/50),而在良性病变者中则分别为2%(1/50)和0%(0/50),前两者与后者之间相比,差异有显著性(P<0.01).p27低表达与CyclinD1表达(转移组阳性率72.7%,未转移组71.4%)与甲状腺乳头状癌淋巴结转移间无显著相关性(P>0.05).结论:联合检测CK19、Galectin-3和HBME-1对甲状腺乳头状癌的诊断与鉴别诊断具有重要价值,而p27的低表达与CyclinD1表达对甲状腺乳头状癌的淋巴结转移无提示作用.

Expression of cytokeratin 19,galectin-3,HBME-1,p27 and CyclinD1 in thyroid papillary carcinoma and their clinicopathological significance

Background and purpose: The diagnosis of thyroid papillary carcinoma sometimes is difficult, metastasis of lymph node is the major reason of local relapse and influence prognosis.This study explores the immunohistochemical expression and their diagnostic value of CK19,HBME-1,galectin3,p27 and cyclinD1 in thyroid papillary carcinoma and the relations between p27,cyclinD1 and lymph node metastasis of papillary carcinoma.Methods: Immunohistochemical staining was used on 50 specimens of benign lesions (40 speciments of nodular goiters and 10 cases of follicular adenomas) and 50 specimens of papillary carcinomas (40 specimens of classic variants and 10 specimens of follicular variants) operated in our hospital from January of 2005 to December of 2008. Results: CK19,HBME-1 and galectin3 were expressed in cytoplasm or on the membrane, but p27 and cyclinD1 were expressed on the nucleus. The expressions of CK19,HBME-1 and galectin3 in thyroid papillary carcinoma were middle to strong positive, the positive ratios were 100%,96% and 100%, respectively;their expressions in benign lesions were negative or low positive, the positive ratios were 10%,10% and 6%, respectively;there were statistical differences between them (P<0.01). The expression of p27 in thyroid papillary carcinoma was low positive or negative, the positive ratio was 14%, but the expression of p27 in benign lesions was middle to strong positive, the ratio was 84%, there was also significant difference between them(P<0.01). The expression of CyclinD1 were similar in benign and malignant lesions of thyroid, the positive ratios were 68% and 78%, respectively, there was no statistical difference between them(P>0.05). There were significant differences(P<0.01) between the benign lesions and the papillary carcinomas in terms of the combination of CK19,HBME-1 and galectin3 expression and there were no significant differences(P>0.05) in the group of the former with underexpression of p27 between the two groups. The differences were not statistically significant (P>0.05) between the underexpression of p27 with the expression of cyclinD1 (the positive ratios in metastasis group and no metastasis group are 72.7% and 71.4%) in the lymph node metastasis. Conclusion: The combined immunohistochemical stainings of CK19,HBME-1 and galectin3 are useful on the diagnosis and differential diagnosis of thyroid papillary carcinoma, there is no predicted value of the underexpression of p27 with the expression of cyclinD1 for lymph node matastasis of thyroid papillary carcinoma.